Mood Disorders

  1. Whats the difference between depression and grief?
    • Grief reaction:
    • --Normal reaction to loss
    • --Related to significant loss
    • --Stop normal activities
    • --Focus on present feelings & needs
    • --Adjustment is the outcome
    • Grief reaction can become abnormal:
    • --Depression can be a distorted grief reaction.
    • --Grief can become pathological grief reaction
  2. Affective SnSs of Depression
    • Anger & anxiety
    • Apathy & bitterness
    • Dejection & guilt
    • Denying feelings
    • Sad and despondent
    • Helpless & hopeless
    • Loneliness
    • Low self-esteem
    • Worthlessness
  3. Cognitive SnSs of depression
    • Ambivalence
    • Confusion, uncertainty
    • Unable to concentrate
    • Indecisiveness/loss of motivation
    • Loss of interest
    • Pessimism & self- depreciation
    • Self-destructive thoughts 
    • Suicidal ideation. At risk when pt has lost hope of recovery.
  4. Behavioral SnSs of depression
    • Aggressiveness
    • Immobility
    • Agitation
    • Decreased activity. Requires prompting to accomplish ADLs. 
    • Intolerance/anger
    • Irritability
    • Lacks spontaneity
    • Suicidal gestures & acts
    • Underachievement
    • Withdrawal
    • Poor hygiene & lack of ADLs
    • Dependent
    • Social isolation/withdrawn
    • Tearful
    • Alcoholism & drug use-
    • Self-medication
  5. Who is at risk for suicide?
    • Decreased 5HT (serotonin) and/or NE (norepinephrine)
    • Women
    • People with chronic, debilitating illness
    • History of depression
    • Concurrent psychiatric illnesses:
    • -  Substance Abuse/Dependence
    • -  Panic disorder
    • -  Bipolar disorder
    • -  Obsessive-compulsive disorder
    • Prior suicide attempts
    • Negative Evaluation of Self
    • -  Pessimism & negative evaluation of self/others/world
    • -  Cognitive distortions and faulty thinking
    • Lack of social support
    • Stressful life events
    • Personal history of sexual abuse
    • Sexual orientation issues
    • People with unresolved grief
    • Humiliating life event
  6. When does depression become major depression?
    When it lasts more than 2 weeks. 
  7. What is anhedonia?
    When a depressed pt can no longer experience pleasure in an activity they used to find pleasurable. 
  8. What is dysthymia?
    • When depression lasts 2 or more years. May occur in a pattern with more days depressed than not.
    • Symptoms are generally not as severe as with major depression. 
  9. What are some theories of depression?
    • Psychoanalytic: associated with loss & is anger turned inward against the self
    • Beck-Cognitive Therapy: Negative and faulty thinking 
    • Neurochemical imbalance: Low levels of 5HT (serotonin)/ Low levels of norepinephrine
  10. What are some nursing interventions for a pt with depression?
    • Administer Medications (See Medication Sheet):
    • --SSRI’s
    • --Tricyclics
    • --MAO inhibitors
    • --Others antidepressants
    • Monitor medication side effects, especially loss of appetite. Must be getting food/fluids. 
    • Assess suicidal ideation
    • 1:1 for short periods
    • Cognitive restructuring for thinking
    • Deal with anger and externalize as needed
    • Avoid acting cheerful
    • Mute-make observations of patient’s  response to environment & document
    • Use simple, concrete words and sentences
    • Work on problems to gain acceptance of self
    • Cognitive restructuring for distortions in thinking
    • What to do for paradoxical calm? Paradoxical calm is when pt with suicidal ideation suddenly gets better because they've come up with a plan, and having a plan makes them feel good. Do not d/c and watch closely for suicide attempts.
  11. How do SSRIs work?
    • Image Upload 1
    • Seratonine Synapse Reuptake Inhibitor.
    • Blocks seratonine's ability to taken up when it does not enter a receptor. 
  12. How do you assess for suicidal ideation?
    • “Are you thinking about killing yourself?”
    • “Have you thought about hurting yourself?”
    • “When people are as upset as you seem to be, they sometimes wish they were dead.  I’m wondering if you are thinking about harming yourself?”
    • Presence of a plan & lethality
    • “Are you thinking about hurting yourself right now?  If that changes, will you promise to talk with someone before you make an attempt?”
    • Nurse’s role in documentation
    • Assess overt/covert cues
    • --Covert: Hoarding clues, giving things away, saying good-bye, getting affairs in order.
  13. What are some nursing interventions for pt with suicidal ideation?
    • Ask directly about suicidality
    • Document patient safety and action taken
    • Unit & patient searches to provide safe environment 
    • Remove harmful objects
    • Suicide precautions
    • 15 min, 30 min. and hourly checks
    • 72 hour holds
    • Monitor patient closely
    • Sitter for extreme suicidality
    • Line of site
    • Watch for elopement
  14. What to do for Treatment Resistant Depression Major.
    • Electroconvulsive Therapy: Thought to increase dopamine, serotonin, and norepinephrine by various mechanisms
    • Vagus Nerve Stimulator: Placement of internal device used for epilepsy
    • Functional EEG: matching of medication
  15. What is mania?
    • Elevated mood including 3 of the following: 
    • Inflated self-esteem or grandiose
    • Decreased sleep
    • Increase talkativeness  
    • Pressured speech: speaking on top of yourself. Words cannot flow fast enough. 
    • Flight of ideas 
    • Thoughts racing
    • Distractible 
    • Agitation
    • Increase in goal-directed activity (socially, at work or sexually)
    • Excessive involvement in pleasurable activity
    • Sexual indiscretions, buying sprees, foolish business investments
  16. What is hypomania?
    • About the same as mania, but less and no psychotic symptoms. 
    • Less severe than for mania
    • Less impairment in social/occupational functioning
    • Does not usually need hospitalization
  17. Bipolar I vs II
    • I: Is predominately manic with a few depressed episodes
    • II: Is predominately depressed with a few manic or hypomanic episodes.  Harder to diagnose

    Both are genetic and are characterized by a chemical imbalance in the brain.
  18. What is bipolar depression?
    • More amendable for treatment
    • Symptoms similar to Major Depression
    • Monitor for suicidal ideation
    • Medication used to treat are different
    • Use of Mood Stabilizers
    • Antidepressants used with caution since they can precipitate manic episodes
  19. What are nursing interventions for pt with bipolar disorder?
    • Administer medications & monitor side effects (1st line intervention is Rx)
    • --Lithium (Therapeutic vs toxic levels)
    • --Tegretol
    • --Depakote 
    • --Others
    • Administer low doses of antipsychotics, to decrease impulsive behaviors. 
    • PRN Benzodiazepines: helps to focus and relax. 
    • Give finger foods. 
    • Give fluids to drink
    • --Want high calories because they will be burning them at a tremendous rate. 
    • Do not laugh at jokes
    • Use firm, calm approach
    • Use short, simple words & explanations
    • Be consistent with approach
    • Set limits on behavior
    • Provide a structured environment
    • Avoid power struggles
    • Send to room to calm down if escalates
    • De-escalate
    • Use time outs
    • Distraction
    • Redirect energy constructively
    • Protect from self harm
    • Remain calm
  20. How do you monitor for Lithium toxicity?
    • Vary narrow therapeutic level. 
    • (Level indicates multiple above therapeutic level.) 
    • 2.0 level:
    • Anorexia
    • Nausea/vomiting
    • Diarrhea
    • Coarse hand tremor
    • Twitching
    • Lethargy
    • Hyperactive deep tendon reflexes
    • Tinnitus
    • Vertigo
    • Weakness
    • Drowsiness

    • Over 2.5:
    • Fever,
    • decrease urine output,
    • decreased BP,
    • irregular pulse, 
    • ECG changes,
    • impaired consciousness,
    • seizures,
    • coma and death
Card Set
Mood Disorders
Mental health